Campylobacter jejuni: Difference between revisions
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==Background== | ==Background== | ||
* [[Gram negative]], non spore forming bacteria | *[[Gram negative]], non spore forming bacteria | ||
* Commonly found in animal feces | *Commonly found in animal feces | ||
* Caused by oral-fecal transmission | *Caused by oral-fecal transmission | ||
* Associated with [[Guillain-Barre syndrome]] and Reiter syndrome | *Associated with [[Guillain-Barre syndrome]] and [[Reactive arthritis|Reiter syndrome]] | ||
*Incubation period of about 2-5 days, with duration of illness around 2-10 days<ref>U.S. Dept of Health and Human Services. Campylobacter. https://www.foodsafety.gov/poisoning/causes/bacteriaviruses/campylobacter/index.html</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
* Acute diarrheal illness (<3 weeks) | *Acute diarrheal illness (<3 weeks) | ||
* Severe [[abdominal pain]] | *Severe [[abdominal pain]] | ||
* [[Fever]] | *[[Fever]] | ||
* Bloody/voluminous/purulent stools | *Bloody/voluminous/purulent stools | ||
* Systemic illness/symptoms | *Systemic illness/symptoms | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* Infectious: | *Infectious: | ||
** [[Salmonella]] | **[[Salmonella]] | ||
** [[Shigella]] | **[[Shigella]] | ||
** Shiga toxin-producing [[E. coli]] | **Shiga toxin-producing [[E. coli]] | ||
** [[E. coli]] 0157:H7 | **[[E. coli]] 0157:H7 | ||
** [[Entamoeba histolytica]] | **[[Entamoeba histolytica]] | ||
** [[Yersinia]] | **[[Yersinia]] | ||
** [[Vibrio]] | **[[Vibrio]] | ||
** [[C. difficile ]] | **[[C. difficile ]] | ||
* Non-infectious: | *Non-infectious: | ||
** [[Inflammatory bowel disease]] | **[[Inflammatory bowel disease]] | ||
** [[GI bleed]] | **[[GI bleed]] | ||
** [[Adrenal insufficiency]] | **[[Adrenal insufficiency]] | ||
** [[Mesenteric ischemia]] | **[[Mesenteric ischemia]] | ||
** [[Thyroid storm]] | **[[Thyroid storm]] | ||
** [[Toxicologic exposure]] | **[[Toxicologic exposure]] | ||
** [[Radiation syndrome]] | **[[Radiation syndrome]] | ||
{{Diarrhea DDX}} | |||
== | ==Evaluation== | ||
''Not every patient with fever and diarrhea requires work-up - use clinical judgement'' | |||
*Consider work-up for patient with: | |||
**Fever | |||
**Toxic appearance | |||
**Diarrhea lasting >3 days | |||
**Blood or pus in stool | |||
**Immunocompromised patients with presumed infectious diarrhea | |||
*Bacterial stool culture | |||
**N.B. - In many labs, stool culture tests for [[Salmonella]], [[Shigella]], and [[Campylobacter]] | |||
*Stool ova and parasites if concern for parasitic infection | |||
*Consider [[C. difficile]] PCR if patient has risk factors | |||
==Management<ref>http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/#treat</ref>== | ==Management<ref>http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/#treat</ref>== | ||
* Fluid resuscitation- oral rehydration therapy preferred | *Fluid resuscitation - oral rehydration therapy preferred | ||
* Avoid antimotility agents with bloody diarrhea | *Avoid antimotility agents with bloody diarrhea | ||
* Many recover without antimicrobial therapy | *Many recover without antimicrobial therapy | ||
* Antibiotics if severe illness: | *Antibiotics if severe illness: | ||
** [[Macrolides]] | **[[Macrolides]] (e.g. [[Azithromycin]]) | ||
**[[Fluroquinolones]] (e.g. [[Ciprofloxacin]]) | |||
** [[Fluroquinolones]] | **Note - resistance is becoming prevalent (up to 25% resistance with [[ciprofloxacin]]<ref>CDC. Campylobacter (Campylobacteriosis) - Antibiotic resistance. Last modified October 2, 2017. https://www.cdc.gov/campylobacter/campy-antibiotic-resistance.html</ref>) | ||
* Note- resistance is becoming prevalent | |||
==Disposition== | ==Disposition== | ||
* | *Most patients can be discharged | ||
* Admit for rehydration in those with severe illness/inability to tolerate PO | *Admit for rehydration in those with severe illness/inability to tolerate PO | ||
==See Also== | ==See Also== | ||
*[[Diarrhea]] | *[[Diarrhea]] | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 01:46, 12 October 2018
Background
- Gram negative, non spore forming bacteria
- Commonly found in animal feces
- Caused by oral-fecal transmission
- Associated with Guillain-Barre syndrome and Reiter syndrome
- Incubation period of about 2-5 days, with duration of illness around 2-10 days[1]
Clinical Features
- Acute diarrheal illness (<3 weeks)
- Severe abdominal pain
- Fever
- Bloody/voluminous/purulent stools
- Systemic illness/symptoms
Differential Diagnosis
- Infectious:
- Salmonella
- Shigella
- Shiga toxin-producing E. coli
- E. coli 0157:H7
- Entamoeba histolytica
- Yersinia
- Vibrio
- C. difficile
- Non-infectious:
Acute diarrhea
Infectious
- Viral (e.g. rotavirus)
- Bacterial
- Campylobacter
- Shigella
- Salmonella (non-typhi)
- Escherichia coli
- E. coli 0157:H7
- Yersinia enterocolitica
- Vibrio cholerae
- Clostridium difficile
- Parasitic
- Toxin
Noninfectious
- GI Bleed
- Appendicitis
- Mesenteric Ischemia
- Diverticulitis
- Adrenal Crisis
- Thyroid Storm
- Toxicologic exposures
- Antibiotic or drug-associated
- Inflammatory bowel disease
Watery Diarrhea
- Enterotoxigenic E. coli (most common cause of watery diarrhea)[2]
- Norovirus (often has prominent vomiting)
- Campylobacter
- Non-typhoidal Salmonella
- Enteroaggregative E. coli (EAEC)
- Enterotoxigenic Bacteroides fragilis
Traveler's Diarrhea
- Giardia lamblia
- Cryptosporidiosis
- Entamoeba histolytica
- Cyclospora
- Clostridium perfringens
- Listeriosis
- Helminth infections
- Marine toxins
- Ciguatera
- Scombroid poisoning
- Paralytic shellfish poisoning
- Neurotoxic shellfish poisoning
- Diarrheal shellfish poisoning
Evaluation
Not every patient with fever and diarrhea requires work-up - use clinical judgement
- Consider work-up for patient with:
- Fever
- Toxic appearance
- Diarrhea lasting >3 days
- Blood or pus in stool
- Immunocompromised patients with presumed infectious diarrhea
- Bacterial stool culture
- N.B. - In many labs, stool culture tests for Salmonella, Shigella, and Campylobacter
- Stool ova and parasites if concern for parasitic infection
- Consider C. difficile PCR if patient has risk factors
Management[3]
- Fluid resuscitation - oral rehydration therapy preferred
- Avoid antimotility agents with bloody diarrhea
- Many recover without antimicrobial therapy
- Antibiotics if severe illness:
- Macrolides (e.g. Azithromycin)
- Fluroquinolones (e.g. Ciprofloxacin)
- Note - resistance is becoming prevalent (up to 25% resistance with ciprofloxacin[4])
Disposition
- Most patients can be discharged
- Admit for rehydration in those with severe illness/inability to tolerate PO
See Also
External Links
References
- ↑ U.S. Dept of Health and Human Services. Campylobacter. https://www.foodsafety.gov/poisoning/causes/bacteriaviruses/campylobacter/index.html
- ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
- ↑ http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/#treat
- ↑ CDC. Campylobacter (Campylobacteriosis) - Antibiotic resistance. Last modified October 2, 2017. https://www.cdc.gov/campylobacter/campy-antibiotic-resistance.html